Ebony Chisolm

NPI #1487301446 in Jackson, Michigan

Provider Information

NPI Number: 1487301446
Entity Type: Individual
Name: Ebony Chisolm
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Technician, Other
Enumeration Date: Mar 9, 2022
Last Updated: Mar 9, 2022

Practice Location

Address: 1001 LAURENCE AVE STE E
City: Jackson
State: Michigan
ZIP Code: 49202-2980
Phone: (517) 750-4777

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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